The Center of Excellence in Retina Diseases, Rajavithi Hospital (COE) and the Institute of Medical Research and Technology Assessment (IMRTA), both in the Department of Medical Services, Ministry of Public Health, proposed this initiative.
We work in the COE, which is a center of medical excellence that has commitments in pursuing excellence in being a tertiary care center, research center, reference center, establishing a regional referral center, proper technology transfer, medical network, and advocacy in national policy.
We chose to solve a problem of DR because it was the leading cause of blindness from retina diseases and the most common eye disease referred to our hospital. It is still the most common eye disease referred in the past three years (1,777/3,335 [53.3%] in 2009, 3,453/5,692 [60.7%] in 2010, 6,880/10,305 [66.8%] in 2011). Furthermore, this initiative could fit well into all the seven areas of excellence we committed to pursue.
The IMRTA has collaborated closely with us in assessing the use of digital retinal images for DR management. We organized skill transfer courses for establishing local community DR Management teams in rural areas. We developed the course curriculum, recruited volunteers, and conducted the teaching together. This initiative fit perfectly with the priority policy of the Department of Medical Services of the Ministry of Public Health in tackling problems of chronic non-communicable diseases, such as diabetes.
The local community DR Management team implements this initiative in their community. The team, the diabetic patients in their area, the COE, and the IMRTA are the major stakeholders. The followings are other stakeholders.
Other Government Bodies:
The Office of the Permanent Secretary of the Ministry of Public Health (OMPH), the command body for all provincial and community hospitals in Thailand, supports the roles of personnel in the hospitals to form the DR Management team with us.
The National Health Security Office (NHSO), a government agency responsible for health care payments in Universal Coverage insurance scheme in Thailand, has endorsed this initiative. NHSO has played an important role in providing budget for retinal image interpretations, and treatment when this initiative is implemented at a national level.
We co-operated with the Thai Retina Society (TRS), in which attending staff from our COE are currently Chair and committee members, to organize a group discussion for retina specialists in Thailand to set up a guideline for DR management. There was a consensus from the meeting that health care personnel that were not physicians could be trained to assist ophthalmologists to prevent blindness from diabetes.
The Royal College of Ophthalmologists of Thailand (RCOPT) endorsed the guideline. We published it in the Thai Journal of Ophthalmology, and were invited to present it in the annual academic meeting of the RCOPT. The TRS and RCOPT have still provided academic support for this initiative.
Village health volunteers work closely with the local DR management team in registration of patients with diabetes into this initiative. They also take care of the patients on the screening days.